Individual provider Active NPI

Larry J Oneill, D.M.D.

  • General Practice Dentistry
  • Elizabeth, CO
National Provider Identifier
1174521348
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7544 Issued in CO
Practice address
779 Crossroads CR
Elizabeth, CO 80107-7466
Phone
(303) 646-3935
Fax
(303) 379-5380
NPI assigned
Jul 12, 2005
Last updated
Apr 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7544 CO Primary

Addresses

Primary practice location

779 Crossroads CR
Elizabeth, CO 80107-7466

Mailing address

PO Box 2466
Elizabeth, CO 80107-2466
Phone (303) 646-3935

Other identifiers 1

IdentifierTypeStateIssuer
1170084826OtherNPPES

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.runningcreekdental.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210208001857 CO Practitioner - Dentist 3678728797

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7544COMDGeneral Practice Dentistry

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1174521348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2466",
            "city": "ELIZABETH",
            "state": "CO",
            "postal_code": "801072466",
            "telephone_number": "303-646-3935",
            "fax_number": "303-379-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "779 CROSSROADS CR",
            "city": "ELIZABETH",
            "state": "CO",
            "postal_code": "801077466",
            "telephone_number": "303-646-3935",
            "fax_number": "303-379-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ONEILL",
        "first_name": "LARRY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2021-04-07",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "7544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1170084826",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.runningcreekdental.com",
            "affiliation": "N",
            "endpointDescription": "practice website",
            "address_1": "779 Crossroads Cr",
            "city": "Elizabeth",
            "state": "CO",
            "country_code": "US",
            "postal_code": "801077466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elizabeth, CO

Sources for this page

Verify at the official NPI Registry.